Treatment of chronic osteitis of the tibia]

Since the beginning of May 1990, we have been using the original Ilisarov apparatus in our treatment of osteomyelitis. It has been used both statically and dynamically after corticotomy for segment transport and lengthening. So far we have treated 24 patients, of whom 13 had defect osteomyelitis, 9 had unstable infections and 2 had stable osteomyelitis with deformities. On average the bone defects measured 7.6 cm, and nine patients had soft tissue defects larger than 6 cm2. The Ilisarov apparatus performed a holding function in seven cases after defect grafting using autogeneic spongiosa. It was used in four cases for gradual compression, in seven cases for segment or fragment transport, in three cases for secondary lengthening and in three cases for correction. In all cases the infections were eliminated and stability was obtained. The duration of segment transport corresponded to the defect size, with a daily lengthening of approximately 1 mm. The fixation times ranged from 112 to 483 days (mean: 240 days). Apart from one special situation, no bone regeneration problems were observed. Some of the complications we encountered must be regarded as beginners' mistakes. We observed problems with segment transport (early corticotomy healing, deformity, non-union at the docking site) and problems with equipment, which has now been improved. For closure of the soft tissue defects it was sufficient to use mesh grafting. Its versatility and advantages as a stabilizing apparatus have made the Ilisarov fixator the instrument of our choice, especially in the treatment of circular infected defects larger than 3 cm.